TY - JOUR
T1 - Limited positive predictive value of β-d-Glucan in hematologic patients receiving antimold prophylaxis
AU - Chang, Euijin
AU - Kim, Taek Soo
AU - Kang, Chang Kyung
AU - Jun, Kang Il
AU - Shin, Dongyeop
AU - Koh, Youngil
AU - Hong, Junshik
AU - Choe, Pyoeng Gyun
AU - Park, Wan Beom
AU - Kim, Nam Joong
AU - Yoon, Sung Soo
AU - Kim, Inho
AU - Oh, Myoung Don
N1 - Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background. Diagnostic value of β-d-glucan (BDG) in populations with low prevalence of invasive fungal infection (IFI), such as hematologic patients receiving antimold prophylaxis, should be re-evaluated. Methods. We retrospectively reviewed episodes with BDG results in hematologic patients receiving antimold prophylaxis from January 2017 to August 2019 in a tertiary hospital. The episodes were classified as true positive ([TP] positive BDG with IFI), true negative ([TN] negative BDG without IFI), false positive ([FP] positive BDG without IFI), false negative ([FN] negative BDG with IFI), and nonevaluable. Results. A total of 203 episodes were analyzed: 101 episodes (49.8%) were from stem cell transplants, 89 (43.8%) were from induction chemotherapy, and 13 (6.4%) were from graft-versus-host disease treatment. There were 62 nonevaluable episodes. Among 141 evaluable ones, there were 8 (5.7%) episodes of probable/proven IFI. True positive, TN, FP, and FN cases were 4 (2.8%), 112 (79.4%), 21 (14.9%), and 4 (2.8%) episodes, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 50.0%, 84.2%, 16.1%, and 96.5%, respectively. Positive predictive value was 26.7% and 0.0% in diagnostic and surveillance episodes, respectively. Conclusions. β-d-glucan test should be used to exclude IFI rather than for diagnosis in these patients.
AB - Background. Diagnostic value of β-d-glucan (BDG) in populations with low prevalence of invasive fungal infection (IFI), such as hematologic patients receiving antimold prophylaxis, should be re-evaluated. Methods. We retrospectively reviewed episodes with BDG results in hematologic patients receiving antimold prophylaxis from January 2017 to August 2019 in a tertiary hospital. The episodes were classified as true positive ([TP] positive BDG with IFI), true negative ([TN] negative BDG without IFI), false positive ([FP] positive BDG without IFI), false negative ([FN] negative BDG with IFI), and nonevaluable. Results. A total of 203 episodes were analyzed: 101 episodes (49.8%) were from stem cell transplants, 89 (43.8%) were from induction chemotherapy, and 13 (6.4%) were from graft-versus-host disease treatment. There were 62 nonevaluable episodes. Among 141 evaluable ones, there were 8 (5.7%) episodes of probable/proven IFI. True positive, TN, FP, and FN cases were 4 (2.8%), 112 (79.4%), 21 (14.9%), and 4 (2.8%) episodes, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 50.0%, 84.2%, 16.1%, and 96.5%, respectively. Positive predictive value was 26.7% and 0.0% in diagnostic and surveillance episodes, respectively. Conclusions. β-d-glucan test should be used to exclude IFI rather than for diagnosis in these patients.
KW - Antimold prophylaxis
KW - Fungal diagnostics
KW - Hematologic diseases
KW - β-d-glucan
UR - http://www.scopus.com/inward/record.url?scp=85087424012&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofaa048
DO - 10.1093/ofid/ofaa048
M3 - Article
AN - SCOPUS:85087424012
SN - 2328-8957
VL - 7
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 3
M1 - ofaa048
ER -
